Aetna Choice® POS II Plan

Department of Defense
Nonappropriated Fund
Health Benefits Program
AF Health Benefits Program
DoD N
Aetna Choice
POS II Plan
®
Product guide for 2016
Table of Contents
Your Life, Your Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Medical Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Choice POS II Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Teladoc®: 1-800-835-2362. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stay Well with Choice POS II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Earn a Health Incentive Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Incentive Credit Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Metabolic Syndrome/Biometric Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Prescription Drug Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Four Tier Pharmacy Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pharmacy Advisor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Visit a Participating Retail Pharmacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Choose Generics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Migraine Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Use the Aetna Rx Home Delivery Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Price-A-Drug. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Preferred Drug List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tobacco Cessation Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Anti-Obesity Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn More About Your Rx Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Online Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Aetna Navigator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cost of Care Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DocFind. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iTriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Personal Health Record (PHR). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PatientsLikeMe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Go Mobile with Aetna. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Health and Wellness Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Simple Steps To A Healthier Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Aetna Health Connections Disease Management Program. . . . . . . . . . . . . . . . . . . . .
24/7 Nurse Line: 1-800-556-1555. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The National Medical Excellence Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Dental Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Passive PPO Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Stand Alone Dental Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Discount Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vision Discounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hearing Discounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fitness Discounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Natural Products and Services Discounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Weight Management Discounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Aetna Member Services: 1-800-367-6276. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Enrollment Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Your Life,
Your Health
The Department of Defense (DoD) Nonappropriated Fund (NAF) employers
are pleased to offer you and your family a program of health benefits that
includes medical, prescription drug and dental coverage.
Nothing makes life easier and more enjoyable than good health. This is why
your DoD NAF Health Benefits Program does more than just pay medical bills.
It provides services and programs to help you stay well, prevent problems
and enjoy a better quality of life. In this guide, you’ll find information about
online services and wellness programs designed with your good health and
convenience in mind.
In addition to this guide, more information can be found on the DoD NAF
benefits website at www.nafhealthplans.com (for active employees) or
www.nafhealthplans.com/retiree (for retirees).
This is an especially important resource that puts benefits information and
enrollment tools and instructions in one convenient place. Here you will
find product brochures and benefit summaries that detail your medical
and dental benefits, and information about Flexible Spending Accounts.
The site also features a section dedicated to Health Care Reform (HCR)
where you will find all required notices (including the Summary of Benefits
and Coverage statements), plus news about HCR-related changes to your
coverage. Visit the Wellness & Resources section for information about
Health Incentive Credits and other programs that will help you understand
the cost of care and make informed decisions to help save you money.
Information is added as it becomes available, so be sure to check the site
from time to time for the latest updates.
The DoD NAF benefits website is also where you’ll find materials specific
to your employer, such as contact information, forms and other documents.
As updates to these references become available, they will be posted to
the site.
Questions?
If you need help or information, call Aetna Member Services at
1-800-367-6276.
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Medical Benefits
Your DoD NAF Health Benefits Program (HBP) provides
medical benefits through the Aetna Choice POS II Plan.
This is a preferred provider organization plan that gives
you the freedom to receive care from any licensed health
care provider and the opportunity to save when you use
preferred providers (doctors and other health care providers
who belong to the Aetna network).
You can also request a printed directory by calling Member
Services at 1-800-367-6276.
The Choice POS II Summary of Benefits chart, available at
www.nafhealthplans.com, shows preferred (in-network)
and non-preferred (out-of-network) benefits side by side.
What is Precertification?
Precertification is the advance review of a hospital admission
to ensure that the setting and length of stay are appropriate
to the diagnosis. Here’s what you need to know:
The Choice POS II Plan
The Choice POS II Plan makes it easy to get the quality
health care services you and your family need. When you use
preferred providers, there are no claim forms to complete and
no precertification process for you to initiate. In addition, plan
benefits are based on special negotiated rates rather than
recognized charges.
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About the Aetna Network and Preferred Benefits
Choice POS II is a network plan, which means you get the
highest level of benefits when you choose doctors, hospitals
and other health care providers who belong to the Aetna
network. A broad range of medical specialties and services is
available within the network so you and your family can get
the care you need.
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Because preferred providers deliver health care services at
special negotiated rates, you pay less for your care. All doctors
and hospitals are screened before they are admitted to the
network, and monitored on an ongoing basis once they are
in the network. Credentials and licenses are checked to make
sure they are valid and current.
Receiving Care Away from Home
Aetna maintains Choice POS II provider networks throughout the
country that you may use. If you are out of your local network
area on vacation or business, and you need non-emergency
health care services, call Member Services. Ask the Aetna
representative if you are in or near a network area. If so, you may
use network providers and receive the preferred level of benefits.
If you use non-network providers, your care will be covered at the
non-preferred level of benefits. If you are traveling overseas, your
covered expenses will be paid at the preferred level. For these
situations, you will need to pay the bill at the time of service,
then submit a claim form to Aetna to be reimbursed.
When You Need Care
Each time you seek medical attention you have a choice:
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If your doctor recommends a hospital stay, the
precertification process must be initiated by calling Member
Services at least 14 days before you are admitted to the
hospital. When you use a preferred provider, he or she will
take care of this requirement for you. If you use a nonpreferred provider, you need to take care of it yourself.
If you use a non-preferred provider and you do not call
Member Services to precertify a hospital admission, you will
be required to pay a penalty of $500. The penalty will apply
each time you fail to precertify.
The precertification requirement is waived for emergency
admissions, hospital care received overseas and for those
who have Medicare as their primary coverage.
isit preferred (in-network) providers who belong to
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the Aetna network. You’ll receive a higher level of benefits,
and those benefits will be based on negotiated rates that
are generally lower than those charged by non-preferred
providers. Preferred providers will also file claims for you
and take care of the plan’s precertification requirement for
hospital admissions.
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isit non-preferred (out-of-network) providers. You’ll
receive a lower level of benefits, and those benefits will be
based on the recognized charge for a given medical service
in your area. The recognized charge amount is the prevailing
rate for medical services in your community. You’ll also be
required to file your own claims and contact Aetna to initiate
the precertification process for hospital admissions.
If your child is away at school or lives with another parent
outside your home network, you should call Member Services
and ask if there is a Choice POS II network at that location.
If so, log in to DocFind to locate participating providers in that
area. If your child’s school or home is not in a Choice POS II
network, ask Member Services if there is one nearby. If your
child is willing to travel to see network providers, benefits will
be paid at the preferred level.
If a network is not available where your child is living and he or
she is not willing to travel to see network providers, your child’s
benefits will be paid at the Traditional Choice® Indemnity Plan
level of benefits. Traditional Choice is offered to employees and
retirees who live in an area where Choice POS II is not available.
Under Traditional Choice, covered expenses are typically paid
at 80% (based on recognized charges) after the deductible is
met. To be recognized for covered expenses, you must submit
a claim form to Aetna.
Choosing preferred providers means you’ll receive preferred
benefits and save money each time you need care. The Choice
POS II network is large and comprehensive, which means
you’ll likely find that many of the doctors and other health
care providers in your area already participate. To find
preferred providers near you, use the DocFind® online provider
directory at www.aetna.com. Turn to Online Resources on
page 10 of this guide for more about DocFind.
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United States to get preferred rates for prescription drugs (see
page 7 for details). Pharmacy copays are listed on your ID card.
If you don’t use participating pharmacies, you won’t have any
coverage for prescriptions.
Important: You must let Member Services know about any
dependent child who fits the category of benefits described
above. The child’s eligibility must be identified as Traditional
Choice within the claim system in order to receive this level
of benefits.
Sharing the Cost
You share in the cost of your care by meeting an annual
deductible and paying coinsurance and copays.
In an Emergency
If you have a true medical emergency, go to the nearest
hospital immediately to get the care you need. Then, call
Member Services. Your benefits will be paid at 90% after a
$350 copay as long as it is a true emergency. If you are
admitted to the hospital, you will not be required to pay the
$350. If you use a hospital emergency room and it’s not a true
emergency, you must pay the $350 copay as well as 50% of
the cost of the services provided, after meeting the deductible.
The annual deductible is the amount you must pay out of
your own pocket each year before the plan begins to pay
benefits. After you meet the plan deductible, you and the
plan share the cost of covered services. This arrangement is
called coinsurance. The plan pays a percentage of the cost
of covered services and you pay the balance.
For some services, such as emergency care, you may pay
a flat fee, or copay.
A true emergency is a severe illness or accident that could
lead to a serious risk to your health, or to death if not treated
immediately. Examples include bleeding that will not stop,
compound bone fractures, loss of consciousness, stroke and
severe chest pains.
Preventive care is covered at 100% when you use
in-network providers.
Sometimes you need urgent — not emergency — care. Sprains
and fevers are examples of this situation. To avoid the high
cost of using the emergency room for non-emergency care,
you should call your network doctor and follow his or her
instructions so your care will be covered at the preferred level.
Walk-in clinics and urgent care facilities are cost-effective
alternatives when your problem is not an emergency, but you
need quick medical attention. Your care is covered at 100%
after a $30 copay when you use an in-network facility.
You can use DocFind to locate these providers in your area.
For more about DocFind, turn to page 10.
Annual
Deductible
Preferred Care Non-Preferred Care
(In-Network)(Out-of-Network)
Individual
$500$1,500
Family of 2
$1,000
$3,000
Family of 3 or more
$1,500
$4,500
Each family member must meet his or her individual
deductible. For a family of two, the deductible is met when
each family member meets his or her individual deductible,
or $1,000. For families of three or more, the deductible limit
is $1,500.
Choice POS II has an annual out-of-pocket maximum that
limits your expenses and protects you from the high cost of
a serious illness or injury. Once your combined deductible,
confinement fees, copays and coinsurance reach this annual
limit, the plan pays 100% of your covered expenses for the
remainder of the plan year.
Teladoc®
Teladoc is a service that lets you consult with primary care
physicians (including pediatricians) by phone or video chat,
24/7 — for just a $10 copay. Talk with a doctor who can
provide treatment and prescribe medication for conditions
such as colds and flu, allergies, bronchitis and more. Visit
www.nafhealthplans.com for more information or call
Teladoc at 1-800-835-2362.
Annual Out-of-Pocket Preferred Care Non-Preferred Care
Limit
(In-Network)(Out-of-Network)
Teladoc is not available to overseas employees and may not be
available in all states.
Your Medical Plan ID Card
All DoD NAF employees, retirees and spouses/same sex domestic
partners enrolled in the DoD NAF HBP will receive a new ID card
in the mail. The cards will have copay information along with the
names of all covered family members and the Member Services
toll-free number on them. Keep your card handy and show it
at the doctor’s office to let them know that you are enrolled in
Choice POS II. Also, show it at participating pharmacies in the
Individual
$3,000$6,000
Family of 2
$6,000
$12,000
Family of 3 or more
$9,000
$18,000
Each family member must meet his or her individual out-ofpocket limit. For a family of two, the out-of-pocket limit is
met when each family member reaches his or her individual
out-of-pocket limit, or $6,000. For families of three or more,
the maximum out-of-pocket limit is $9,000.
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Important: The out-of-pocket maximums include deductibles,
coinsurance and copays. Prescription eyewear, expenses above
maximum allowable amount, non-covered expenses and
amounts above the recognized charge do not count toward
your out-of-pocket maximums.
Maximum allowable amount
The cost of medical procedures can vary from one facility
to another — and while costs may vary widely, quality will
not. To address these differences, Aetna has established a
standard price called the maximum allowable amount for
certain outpatient services. There is a maximum allowable
amount for certain outpatient procedures, including but
not limited to:
In-network expenses are applied to the in-network deductible
only, and the same is true for out-of-network expenses. This
means you will need to meet the full in-network deductible
before benefits are paid for in-network care. Likewise, you
must meet the full out-of-network deductible before benefits
are paid for out-of-network care.
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Please visit www.nafhealthplans.com (for active employees)
or www.nafhealthplans.com/retiree (for retirees) to
find detailed information about your medical benefits
and coverage.
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**To view a complete list of outpatient procedures and their maximum
allowable amounts, log in at www.aetna.com and click I want to . . .
View Deductibles & Plan Limits. Scroll to the bottom of the page and
look for the Maximum Allowable Amount box.
*The Choice POS II Medical Plan is administered by Aetna Life Insurance
Company and is offered to eligible DoD NAF employees, retirees and
dependents who have access to the Aetna Choice POS II network.
Ensure you don’t pay more than you need to
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S cope procedures (colonoscopy, endoscopy)
CT scans and MRIs
Hernia surgery
Tonsillectomy
Carpal tunnel surgery
Cataract surgery, and more**
When you have one of these procedures, the plan will
pay up to the maximum allowable amount toward facility
costs for the service. You pay any facility costs above the
maximum allowable amount.
U
se Aetna’s Member Payment Estimator tool. This
online tool provides personalized cost estimates for
common procedures, including procedures that have a
maximum allowable amount.
Verify your facility costs do not exceed the maximum allowable
amount before you schedule your procedure. Keep in mind
that just because your physician refers you to a particular
provider for an outpatient procedure that the cost may not
necessarily be within the maximum allowable amount. Talk to
your doctor and ask questions.
To use the Member Payment Estimator, log in at
www.aetna.com, click on “Use Member Payment
Estimator” in the Cost of Care box to see a list of facilities
in your area that perform the procedure, and their cost. If
there is a maximum allowable amount for the procedure,
you’ll see estimates that can perform the procedure at or
below the maximum allowable amount.
In the example below, the member has a choice of
scheduling a routine colonoscopy (which is covered at
100% up to the maximum allowable amount) at Facility A
or Facility B. If he selects Facility A, he will be responsible for
an out-of-pocket expense of $500 since that facility charges
$500 more than the maximum allowable amount. However,
if he selects Facility B, he can avoid an out-of-pocket cost
and pay nothing.
Save Money with Quest
You can save money when you use Quest Diagnostics® and
other affiliated labs for blood tests and other lab services.
You’ll pay even less than you would at an in-network lab.
Visit www.nafhealthplans.com for a listing of affiliated labs.
Contact Aetna Member Services at 1-800-367-6276 before
scheduling your procedure to ensure that you understand
what your costs will be. For more information about the
maximum allowable amount, visit the Wellness & Resources
tab at www.nafhealthplans.com.
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Facility cost
of routine
colonoscopy
Maximum
allowable
amount
Member
cost
Facility A
$2,000
$1,500
$500
Facility B
$1,500
$1,500
$0
Stay Well with Choice POS II
The Choice POS II plan provides generous benefits for preventive care services,
which can catch problems early and help you and your family stay well. The following
routine services are covered at 100% with no copay and no deductible when you
receive care from a preferred provider:
ell-baby care, including doctor visits and immunizations
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One annual physical exam (including immunizations)
n One annual gynecological exam, including a Pap test and lab fees
n One annual mammogram for women age 35 and older
n Other preventive care services for women, including contraceptive drugs and
devices, breastfeeding support, counseling for domestic violence and more
n One annual prostate screening for men age 40 and older
n One colonoscopy* every 10 years beginning at age 50
n One annual hearing exam and eye exam
Preventive care benefits are a valuable part of your health plan and an important
step in staying healthy. We encourage you to visit your doctor for these important
exams and screenings.
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*Maximum allowable amount may apply.
Earn a Health Incentive Credit
Each year, you will be able to earn Health Incentive Credits as shown in the chart below:
Health Incentive
Credit amount
Activity
Calendar year maximum
You and your covered spouse/same sex domestic partner (SSDP) must complete the Health Assessment to earn any
incentives. No other activities will earn an incentive until the assessment is completed.
Complete metabolic syndrome
screening before April 1, 2016
$150 each
Complete metabolic syndrome
screening between April 1 and
December 31, 2016
$100 each
Disease Management (DM) goal* –
complete 3 calls with a DM nurse
$100 each
Complete online Journey®
(average time 32 days)
$50 each up to 4 Journeys
$150 for employee only and
$300 for employee and covered spouse/SSDP
$200 for employee only or
$400 for family
Dependent children under age 18
Complete preventive exam for
children under age 18
$50 for each child per year
For all activities, you can earn up to the calendar year maximum of $250 for employee or $600 for family.
*This program is not available to overseas employees.
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Health Incentive Credit Program
2) Metabolic syndrome screening results
Once you have had your screening, you will receive a report
that explains your results. You can share this report with
your doctor and use it to talk about ways to improve your
results — and your health. There is no cost to you for this
important screening — this is a free service for all eligible
employees and their covered spouses/same sex domestic
partners (SSDPs). Visit the Wellness & Resources tab on
www.nafhealthplans.com to learn more. You can earn
a health incentive credit for completing your metabolic
syndrome screening.
The Health Assessment: A requirement before you
can earn
You must complete the Health Assessment first in order to earn
any of the Health Incentive Credits. None of the other activities
will earn credits until you have completed the assessment,
which takes just 10 minutes to complete. You answer questions
about personal and family health history, lifestyle habits, recent
health screening results and other health factors. To take the
assessment, log in at www.aetna.com and click I want to . . .
Take a Health Assessment on your home page.
3) Disease management goal (complete 3 calls with a
disease management nurse)
If you or your covered spouse/SSDP live with one or more
chronic medical conditions (such as asthma, diabetes,
osteoporosis and others), help is available from Aetna’s
disease management program. The program covers over 35
conditions and provides one-on-one support to help participants
understand and follow treatment regimens, make healthy
lifestyle changes and avoid health complications. You’ll be
matched with a disease management coach who will create
an action plan and set goals for your path to better health.
Complete 3 calls with a disease management nurse and you’ll
earn a health incentive credit.
Below provides additional information about each
health incentives:
1) Metabolic syndrome and biometric screenings
Metabolic syndrome is a group of five risk factors that raise your
risk of developing conditions such as heart disease and diabetes.
A biometric screening measures the following risk factors:
Health factor Increased risk if:
Blood pressure
Greater than or equal to
130 over 85 mmHg*
Blood sugar or glucose
Greater than or equal to
100 mg/dL
Triglycerides
Greater than or equal to
150 mg/dL
Central obesity
(waist circumference)
Women: Greater than 35 inches
Men: Greater than 40 inches
HDL cholesterol
Women: Below 50 mg/dL
Men: Below 40 mg/dL
4) Online Journeys
Online Journeys are another part of the wellness program.
When you complete the health assessment, you’ll get an action
plan with recommended online health coaching programs.
You can follow the programs at your own pace to lose weight,
eat healthier, start an exercise program, manage stress or
even get a better night’s sleep without medication. Each
program features “Journeys” that tailor tools and content to
your particular needs and goals. The average time to complete
a Journey is 32 days. You earn an incentive credit for each
journey completed (up to four Journeys total for employee
and covered spouse/SSDP).
*If either the systolic (top number) or diastolic (bottom number) is out of
range, the reading is considered a risk factor.
If you have three or more of the above risk factors, you may
have metabolic syndrome. It is important to start working to
reduce any risk factors you may have now in order to prevent
a serious health condition, such as a heart attack or stroke. In
many cases, these factors can be positively impacted by lifestyle
changes, such as regular exercise and eating a healthy diet.
5) Well child exam
An additional incentive credit(s) will be awarded for preventive
exams received by children under age 18.
How credits are applied
Health Incentive Credits are applied automatically to your
deductible and coinsurance, but not to copay amounts. Any
credits remaining at the end of the year roll over to the next
plan year(s), for up to three years.
6
Prescription Drug Benefits
When you enroll in the Choice POS II Plan, your prescription
drugs will be covered under Aetna’s Premier Plus Four Tier
Pharmacy Plan. Under this plan, you can fill short-term
prescriptions at participating retail pharmacies (up to a 30-day
supply) and long-term prescriptions through the mail-order
service (up to a 90-day supply).
The chart shows how much you’ll pay for prescription drugs:
The Four Tier Pharmacy Plan
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n
n
Your cost for up to a
30-day supply:
Tier One – Generic drugs
$10 copay per prescription
Tier Two – Preferred brand-name drugs $35 copay per prescription
Tier Three – Non-preferred 35% of negotiated price**
brand-name drugs*The minimum you pay
per prescription is $60;
maximum is $125
Whether you visit a participating retail pharmacy or use the
mail-order program, the amount you pay depends on the
type of drug used to fill your prescription. As you can see in
the chart to the right, your pharmacy plan has four levels,
or tiers, of benefits.
n
Using a participating retail pharmacy:
Tier Four – Specialty drugs40% of negotiated price**
The minimum you pay
per prescription is $60;
maximum is $125
ier One: You pay the least for generic drugs — a flat
T
fee, or copay, of $10 per prescription. Generic drugs
are identified by their chemical names. For example,
alendronate sodium is the generic equivalent of Fosamax, a
brand-name drug. See Why generics are a good idea on the
next page.
Tier Two: You pay a $35 copay per prescription for Tier
Two (preferred) brand-name drugs on the plan’s Preferred
Drug List. See The Preferred Drug List on the page 9.
Tier Three: For Tier Three medications, (non-preferred)
brand-name drugs, you pay 35% of the price that has been
negotiated for the drug with participating pharmacies, up
to a maximum of $125 per prescription at retail pharmacies
and $250 per prescription using the mail-order service.
Tier Four: You pay the most for Tier Four specialty drugs.
You pay 40% of the negotiated price. Aetna Specialty
Pharmacy® fills prescriptions for specialty drugs.
Using the mail-order program:
Your cost for a
31 – 90-day supply:***
Tier One – Generic drugs
$20 copay per prescription
Tier Two – Preferred
brand-name drugs
$70 copay per prescription
Tier Three – Non-preferred 35% of negotiated price**
brand-name drugs*The minimum you pay
per prescription is $120;
maximum is $250
*Your pharmacy will automatically fill your prescription with a generic
drug, if one is available. Learn more about the Choose Generics Program
on the next page.
**Participating pharmacies agree to charge discounted prices for prescriptions
filled by Aetna members. Your share of Tier Three and Tier Four drug costs
is a percentage of these discounted (or “negotiated”) prices.
Important: The plan does not cover prescription drugs
purchased at non-participating pharmacies in the
United States, the District of Columbia, Puerto Rico,
Guam or the U.S. Virgin Islands.
***For up to a 30-day supply through mail order, the retail copays listed
above will apply.
Visit a Participating Retail Pharmacy
Pharmacy Advisor®
When you need to fill a short-term prescription, you can get
up to a 30-day supply of medication at retail pharmacies that
belong to the Aetna network (called participating pharmacies).
Take your prescription and your Aetna medical ID card to any
participating pharmacies located in the United States, Puerto
Rico, Guam and the U.S. Virgin Islands. Depending on the
type of drug prescribed, you pay your share of the cost in full
at the time of purchase, as shown in the chart above. There’s
no need to complete a claim form.
Aetna’s Pharmacy Advisor program gives you toll-free
telephone access to pharmacists who can provide
guidance on:
n Medication side effects or missed doses
n Questions to ask your doctor
n Staying on track with multiple medications
n Gaps in your treatment regimen
Your Pharmacy Advisor may also send you educational
materials with more information related to your question
or concern. To talk with a Pharmacy Advisor pharmacist,
call toll-free at 1-877-418-4128, Monday through Friday,
9 a.m. to 8 p.m., or Saturday 9 a.m. to 5:30 p.m., CT.
To find a participating pharmacy near you, use the
DocFind online provider directory at www.aetna.com
(turn to Online Resources on page 10 in this guide for
more about DocFind). Or, call Member Services for a
listing of participating pharmacies.
7
Choose Generics — and save
Choose Generics is a benefit plan that encourages you and your prescribing doctor to choose generic drugs in order to save
money. It focuses on Tier Three brand-name drugs if they have a generic alternative. To get the lowest cost for your prescriptions,
your health plan encourages you to use generic drugs when available. This will help you save money each time you fill a
prescription. You’ll pay more for brand drugs. If a generic drug is available and you choose the brand instead, you’ll pay the
difference in actual cost between the brand and the generic plus the brand copay that applies.
Following are two examples of how much you’ll pay with the Choose Generics program.
Actual
drug cost
Current
copay*
Choose Generics (actual brand cost –
actual generic cost + brand copay)
Choose Generics
cost**
Treats cholesterol
Lipitor® 20mg
Brand
Atorvastatin
Generic
$274.82
$96.19
$9.41
$10.00
$274.82 - $9.41 + $96.19 = $361.60
$274.82
$9.41
Treats fluid retention in people with congestive heart failure, liver disease or a kidney disorder
Lasix® 40mg
Brand
$73.09
$25.58
Furosedmide
Generic
$13.78
$10.00
$73.09 - $13.78 + $60.00 = $119.31
$73.09
$10.00
*Current copay for generic is $10 or actual cost of drug if less, up to a 30-day supply; Current copay for Tier Three Brand is 35% of actual cost of drug
with $60 minimum and $125 maximum.
**You will never pay more than the actual cost of the brand.
If you do choose to fill with a brand-name drug, you won’t pay more than the actual cost of the drug like in the example
above. Remember that if you choose a brand drug, any amount that you pay toward the difference between the brand cost
and generic cost is NOT applied to your plan’s annual out-of-pocket maximum.
If there is a medical need for a brand-name drug, the prescribing doctor can ask for a medical exception and provide the
required documentation to avoid the copay “penalty.” If this applies to you, your prescribing doctor can contact Aetna
beginning January 1, 2016 for a medical exception.
For more information about the Choose Generics program, visit the Wellness & Resources tab on www.nafhealthplans.com.
Why generics are a good idea: When your doctor
prescribes generic medications, you pay the lowest copay
under the plan. It’s important to know that generics have
been approved by the FDA as safe and effective. They
contain the same active ingredients in the same amounts
as brand-name drugs, although they may be a different size,
color or shape.
Migraine Management Program
If you’re one of the millions of Americans who suffer from
migraine headaches, you know their impact on your day-today life and well-being. The Migraine Management Program
provides personalized support that includes educational
materials and a diary that lets you record activities and patterns
of headaches that you can discuss with your doctor. This
program is available for members living in the United States.
8
Use the Aetna Rx Home Delivery® Program
While not all brand-name drugs have a generic equivalent,
many do. If a generic is available for the medication you’re
taking, talk with your doctor about switching to the generic
drug so that the lower copay will apply to your prescription
cost. If you are using a brand-name drug that does not have
a generic equivalent, you may want to ask your doctor about
switching to an equally effective alternative drug that does
have a generic equivalent.
Use Aetna’s mail-order program to save on medications you
need on a regular, long-term basis. You may order a 31 –
90-day supply and enjoy the convenience of home delivery.
Shipping is free and the packaging is confidential. In addition,
you’ll pay less for your medications than you would at a
participating retail pharmacy. You can order a 90-day supply
of medication for what you would pay for a 60-day supply at a
participating retail pharmacy.
Tobacco Cessation Medications
If you have questions about your prescription, registered
pharmacists are available to answer them 24 hours a day,
7 days a week. It’s also good to know that mail-order
pharmacies use the same quality and accuracy checks for
prescriptions as participating retail pharmacies. For more
information, visit Aetna Navigator at www.aetna.com
or call (toll-free) 1-866-612-3862.
If you’re ready to quit using tobacco, your DoD NAF Health
Benefits Program can help. The tobacco cessation benefit
makes it easy for you to find and afford the combination
of medication and counseling that works best for you.
Benefits include full coverage (no copayments) for a 180-day
supply of the following FDA-approved medications:
n
*Aetna Enterprise Provider Database.
n
Estimate the Cost of Prescriptions Online
n
Aetna Navigator features Price-A-DrugSM, an online cost of care
tool that allows you to:
n
n
n
n
Bupropion SR
Nicotine gum
Nicotine patch
n
n
n
Nicotine inhaler
Nicotine lozenges
Nicotine nasal spray
n
Varenicline
To take advantage of this benefit, you must obtain a
prescription from your doctor. Your plan will cover eight
smoking cessation counseling sessions per calendar year.
For more information about pharmacy and counseling benefits
for smoking cessation, call Aetna Member Services at
1-800-367-6276.
E stimate the cost of a prescription drug from a local retail
pharmacy or the mail-order service.
S ee if alternative drug choices, including generics, could
save you money.
L earn key facts about your medications, such as how they
are used and any side effects.
F ind out if there are any coverage limitations for a certain
drug.
Anti-Obesity Medications
Medications used to control weight, covered at their
applicable pharmacy tier cost, are part of your DoD NAF
HBP. Some examples include Belviq (Lorcaserin) and Qsymia
(Phentermine/topiramate ER). Learn more about this category
of drug at www.aetna.com/products/rxnonmedicare/
data/2014/MISC/antiobesity.html.
To use Price-A-Drug, log in to Aetna Navigator and click
the Aetna Pharmacy link at the top of your home page.
On the Aetna Pharmacy Overview page, click the link to
Get drug prices.
Learn More About Your Rx Benefits
The Preferred Drug List
n
The Preferred Drug List shows the generic and brand-name
drugs that are covered under your plan. This list is also called
the “formulary.” All drugs on the list were chosen based on
quality and cost effectiveness.
n
n
For each drug on the list, you’ll see which tier it belongs to
in the Four Tier Pharmacy Plan. The chart on page 7 shows
you what you will pay for the drugs in each of the plan’s tiers.
If you are currently taking a brand-name drug, you can check
the Preferred Drug List for your medication to see whether
it is preferred (Tier Two), non-preferred (Tier Three) or specialty
(Tier Four). The listing for your medication will also display the
name(s) of the generic(s) that can be used as a substitute.
9
nline: Log in to Aetna Navigator at www.aetna.com
O
E-mail: Click Contact Us to e-mail Member Services from
Aetna Navigator
Telephone: Call Member Services at 1-800-367-6276
Online Resources
As an Aetna member, you’ll have access to the following
online services:
n
Aetna Navigator
n
Once you’ve enrolled with Aetna, you can register to use
Aetna Navigator, a secure member website that offers
information to help you manage your health and benefits.
You’ll also find more information about Aetna health and
wellness programs and discounts on health-related products
and services described on pages 12 through 16 of this guide.
On Aetna Navigator, you’ll have a personalized home page,
plus access to:
n
n
n
n
n
D
ocFind, the online provider directory listing the doctors,
dentists, pharmacies, hospitals and other health care
providers in the Aetna network.
B
enefit information, including a list of covered family
members, claim information, and the care management,
wellness and health-improvement programs included with
the plan.
P
harmacy information, including the Preferred Drug List
and the Aetna Rx Home Delivery mail-order service.
Y
our Personal Health Record (PHR), an online medical
record gathered from your claims, your health assessment
and facts you provide on your own.
C
ost of care tools, online tools that let you research and
compare costs before you receive care.
Where to Start
There’s a lot to see and do at Aetna Navigator. To get started,
visit www.aetna.com and click on the Log In/Register link.
Follow the prompts to register. Need help? Ann, the Aetna
Virtual Assistant, provides personal responses to your questions
about registering and logging in to Aetna Navigator.
DocFind
DocFind is an online provider directory, where you can search for
doctors, hospitals and other providers both in and outside the
Aetna network.
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These tools include:
– Member Payment Estimator, which lets you search for
and compare costs for common procedures, treatments
and physician services. It factors in your medical plan
details, to give you a real-time cost estimate based on
your actual benefits.
n
n
n
– P
rice-A-Drug, which lets you compare medication
costs and lower-priced alternatives.
n
– H
ospital Comparison Tool, which lets you compare
facilities in your area based on criteria, such as
complication rates and length of stay.
n
o to www.aetna.com.
G
Scroll down or use the menu to click on Find a Doctor.
If you are an Aetna member and registered with Aetna Navigator, you can log in. On your home page, click on
I want to . . . Find a Doctor, Dentist or Facility.
Once in DocFind, provide the geographic information
requested to start your search.
Choose a Provider Category and a Provider Type.
If you are an Aetna member, under Select a Plan, scroll
down to find Aetna Open Access Plans and select Choice
POS II® for medical providers. For dental providers, select
Dental PPO/PDN.
Once you’ve registered with Aetna Navigator, your plan name
and ZIP code will be filled in automatically when you sign in
and use DocFind.
To access these tools, look for the Cost of Care box on your
Aetna Navigator home page. Log in at www.aetna.com.
n
eliable, up-to-date information on health conditions and
R
other related topics through the Healthwise® Knowledgebase
wellness website.
Member Services, through secure and confidential e-mail.
You can e-mail Member Services with questions and
requests, right from Aetna Navigator.
C
laim features and services that let you check the status
of a claim, find out about claim payments, view Explanation
of Benefits (EOB) statements and ask for e-mail alerts when
new information becomes available. You can e-mail Member
Services with important information already filled in. You can
download claim forms, too.
S elf-service features that let you take care of personal
benefit business, such as printing a temporary ID card,
downloading and printing standard Aetna forms, and
updating personal information.
For each doctor, DocFind provides information about his or her
credentials and practice, including medical school attended,
hospital affiliation(s), board certification, health plans accepted,
languages spoken, office location and hours, and parking
and handicap access. You can even get maps and driving
directions to find a doctor’s office.
You can also use DocFind through your Aetna Mobile app.
Important: DocFind is updated 6 days per week, so it contains
the most current information available.
10
iTriage
PatientsLikeMe®
iTriage® is a free mobile and web app that helps you navigate
the complicated world of health care. With iTriage, you can:
PatientsLikeMe combines social networking (with over
240,000 members) and the latest research-based information
to help Aetna members improve how they live with various
health conditions.
L ook up symptoms and conditions using an interactive
map of the human body
n F
ind the right doctors and services for your problem
or condition
n L
earn about medications
n B
ook appointments and get directions to a facility or
doctor’s office
n L
ook up hospital emergency room wait times.
You can use iTriage on your Apple® or AndroidTM mobile
device. Get it free on Google PlayTM or the App StoreSM.
n
To get started with this free app, look for the link to
PatientsLikeMe on your Navigator home page.
Your privacy is protected. Any personal information you
share as part of this program is kept secure and confidential.
Go Mobile with Aetna
With Aetna Mobile you can use any web-enabled
mobile device to view health plan information
whenever and wherever you want. The free app
lets you find in-network doctors, check prescription
costs and much more. The app works with Apple and
Android mobile devices. To download, text “Apps” to
23862,*or visit www.aetna.com/mobile.
Personal Health Record
The Personal Health Record (PHR) is an online service that
provides a secure and confidential place for all your health
information. Each time you have a new medical claim, it’s
automatically added to your PHR. You can add your own
information too. You can even give permission for your
doctor to see your PHR.
You can also use the free Aetna International Provider
Directory App to search Aetna’s international network of
100,000 health care providers. The app gives you address
and contact information, lets you see providers on a map
and calculates the distance to the office or facility.
Your PHR also provides health alerts and reminders from
MedQuery®, a health-monitoring system. MedQuery gathers
information from your health PHR and compares your
information to the latest medical knowledge. If it sees a
chance to improve your care, it posts an alert on your PHR
home page and sends an e-mail to notify you of the posting.
Your doctor also receives an alert by telephone or fax.
To download, visit the App Store or Google Play from
your device and search “Aetna.”
*Standard text messaging rates may apply.
To find your PHR, visit www.aetna.com and log in to
Aetna Navigator.
All information in your PHR is kept secure and confidential.
It is never shared with your DoD NAF employer. Only you can
see the information in your PHR, unless you decide to let your
doctor see it as well.
11
Health and Wellness Programs
Step 3 — Use the Online Wellness Journeys to Reach
When you enroll in Choice POS II, you and your family can take
advantage of special programs that help you live healthier.
Your Goals
Online Journeys are another part of the wellness program.
When you complete the health assessment, you’ll get an
action plan with recommended online health coaching
programs. You can follow the programs at your own pace to
lose weight, eat healthier, start an exercise program, manage
stress or even get a better night’s sleep without medication.
Simple Steps To A Healthier Life
®
Simple Steps To A Healthier Life is an online wellness
program that gives you information, tools and guidance to
improve your diet, get in shape, cope with stress and learn
about ways to enjoy better health at all stages of life. Here’s
how it works:
Each program features “Journeys” that tailor tools and
content to your particular needs and goals. The average time
to complete a Journey is 32 days.
Step 1 — Complete the Health Assessment
In 2016, you must complete the new Health Assessment first
in order to earn any of the Health Incentive Credits. None of
the other activities will earn credits until you have completed
the assessment.
Earn a $50 Health Incentive Credit for
online Journeys
The Compass® Health Assessment takes just 10 minutes to
complete. You answer questions about personal and family
health history, lifestyle habits, recent health screening results
and other health factors. Since this is a brand new assessment,
you will need to complete it instead of just adding updates.
Your previous answers will not be carried over.
When you complete one online Journey, a $50 Health
Incentive Credit will be applied to your deductible or
coinsurance expenses.* You can earn an Incentive Credit
for up to four Journeys.
*Credit does not apply to copay amounts.
Remember, your answers to the health assessment aren’t set
in stone. You can go back whenever you like to update and
add information. For example, you can add your most recent
blood pressure, cholesterol and other test results. When you
do, you’ll receive an updated program plan based on your
current needs.
It’s Secure and Confidential
Any information you provide as part of the Simple Steps To
A Healthier Life program is kept strictly confidential and is
not shared with your DoD NAF employer. To access the
health assessment, go to www.aetna.com and log in
to Aetna Navigator. Look for I want to . . . Take a Health
Assessment on the left side of your home page.
Step 2 — Receive a Personalized Health Report
and Action Plan
Based on your answers to the health assessment, you will
receive recommendations and an action plan based on your
unique needs. You can choose to participate in that program
or any of the other available online interactive wellness
programs. The best part is you decide how you want to
proceed, and you work through the programs at your own pace.
12
Aetna Health ConnectionsSM Disease
Management Program
If you’re living with one or more chronic conditions (or believe
you may be at risk), you can call Aetna at 1-866-269-4500 to
learn more about the personal help that is available to you, and
get started with the program. You can also submit a request
through Aetna Navigator at www.aetna.com.
If you’re living with one or more continuing health conditions,
your Aetna plan can help. The Aetna Health Connections
program provides information and counseling from nurses
trained in more than 35 different diseases and conditions,
including diabetes, asthma, back pain, osteoporosis and
cystic fibrosis.
24/7 Nurse Line: 1-800-556-1555
Informed Health® Line is a toll-free number you can call
anytime — 24 hours a day, 7 days a week, 365 days a year
— for answers to health-related questions and information to
help you make sound decisions and choices.
Living well with a chronic condition often means embracing a
lifestyle change — which isn’t always easy. Aetna nurses can
help you manage your disease by helping you better understand
your condition and your doctor-prescribed treatment plan.
Through telephone calls from trained, experienced nurses,
the program provides caring outreach and personal attention.
Call the Informed Health Line to Talk With a Nurse
When you have a health question or concern or a health-related
decision to make, you can call the Informed Health Line to talk
with a trained registered nurse who will:
If you have a chronic condition, a program nurse will contact
you to invite you to participate. If you accept, your nurse
consultant will work with you to develop a personal action plan
to help you manage your condition and address your unique
health needs. Your plan will incorporate the latest information
on your condition, provide one-on-one counseling and, if
needed, it may involve the services of other clinical professionals,
such as nutritionists, weight-loss counselors and pharmacists.
n
n
n
n
n
Earn a $100 Health Incentive Credit
n
When you complete 3 calls with a disease management nurse,
a $100 Health Incentive Credit will be applied to your deductible
or coinsurance expenses.*
While the Informed Health Line nurses can’t prescribe drugs
or diagnose medical conditions, they can give you advice,
help you with your choices, and also coach you on how to
communicate better with your doctor.
*Credit does not apply to copay amounts.
Your Privacy is Protected
An important thing to keep in mind about all these services is
that they’re confidential. The information you exchange with
Aetna nurses is kept secure and confidential and is not shared
with your DoD NAF employer. The program is voluntary, so
you have the option to participate — or not. Remember, it’s
about you and your good health.
The National Medical Excellence Program®
For help with extremely complex medical procedures, the
Choice POS II Plan offers the National Medical Excellence
Program from Aetna. This voluntary program provides care
coordination and other services when your doctor decides that
you need to have a highly specialized medical procedure, such
as bariatric surgery or an organ transplant. Coverage includes
surgery for organ and tissue transplants, such as heart, lung,
liver, bone marrow, kidney and pancreas. Certain organ
transplant combinations are also covered.
Another point to remember is that the information and
advice the Aetna nurse provides are not a substitute for the
continuing care and services of your doctor. The idea is to
provide support and information that help you better
understand and follow your doctor’s advice and treatment.
The procedure will be performed at a designated Institutes
of ExcellenceTM hospital. These hospitals have national
reputations for their skill with certain types of organ
transplants and complex medical care. Surgical teams at
these hospitals perform many of these specialized procedures
and have a proven track record of success.
Why Participate in Aetna Health Connections?
n It offers personalized help, information and advice from
a trained medical professional
n It’s secure and confidential
n It’s available to you at no extra cost
n It provides support for more than 35 conditions
If an Aetna nurse contacts you, we hope you’ll take advantage
of all he or she has to offer. Think of it as having your own
health consultant — a knowledgeable medical professional with
answers, ideas and advice you can put into action every day.
nswer health-related questions
A
Help you decide whether to go to a hospital emergency room
Tell you how to take care of a health problem until you
can see a doctor
Help you understand health problems and how they are
treated
Give you guidance on what questions to ask your doctor
Give you the facts about the latest medical treatments and
procedures, and explain their risks and benefits
Your doctor and an Aetna case manager will coordinate
your care. If the hospital is more than 100 miles from your
home, you will also receive a travel and lodging benefit for
you and one companion.
13
Dental Benefits
Finding Network Dentists
To find a network dentist near you, use DocFind.
For more about using DocFind, turn to page 10. You can
also request a printed directory by calling Member Services
at 1-800-367-6276.
When you enroll in the Choice POS II Plan, or an HMO plan
with no dental coverage, you are also eligible to enroll
in the Passive PPO Dental Plan.
The Passive PPO Dental Plan
The Passive PPO Dental Plan offers generous coverage for
preventive care services and gives you the freedom to use any
licensed dentist you wish. It also gives you the opportunity to
save money when you receive dental care from a dentist who
belongs to the Aetna dental preferred provider network.
Important: You must enroll in the Choice POS II Plan,
or an HMO medical plan that does not offer dental coverage,
in order to elect the Passive PPO Dental Plan described in
this section.
How the Plan Works
Network dentists have negotiated their fees with Aetna.
They generally charge less than non-network dentists, so your
benefits are based on a lower cost. This means you pay less
for your dental care. Network dental providers also file claims
for you.
The Stand Alone Dental Plan
If you are looking for dental, but not medical coverage,
you may choose to enroll in the Stand Alone Dental Plan for
dental-only benefits during Open Enrollment or during the
eligibility period for new hires. The Stand Alone Dental Plan
cannot be combined with enrollment in a medical plan under
the DoD NAF Health Benefits Program.
When you receive care from a dentist who does not
participate in the Aetna dental network, your benefits are
based on the recognized charge for that service in your
geographic area — which is higher than the negotiated fee.
As a result, you will pay more. In addition, you may need to
file your own claims with Aetna to be reimbursed for your
covered expenses.
Information about the Stand Alone Dental Plan is available
at www.nafhealthplans.com.
Using a network dentist is voluntary. Either way, the same
services are covered. To encourage good dental health,
the plan pays 100% for preventive care services, with no
deductible. For more advanced care, the plan pays a portion
of the expense, depending on the services you receive.
Please visit www.nafhealthplans.com (for active employees)
or www.nafhealthplans.com/retiree (for retirees) to see a
Summary of Benefits chart that displays how dental services
are covered under the plan.
14
Discount Programs
Hearing Discounts
Once you’ve enrolled in an Aetna plan, you can take
advantage of the Discount Program to save on health-related
products and services. To learn more about your discounts and
how to use them, call Member Services at 1-800-367-6276.
Or, you can go to www.aetna.com, and log in to Aetna
Navigator and link to the Discount Program.
You and your covered family members can save on hearing
exams and the latest hearing aid styles and technologies with
the Aetna hearing discounts. You have two ways to save:
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Vision Discounts
The Aetna vision discounts helps you and your covered family
members save on eye care products and services, including
eyeglasses, contact lenses and solution, and LASIK surgery.
You can even get discounts on such items as eyeglass chains,
designer frames, sunglasses and other vision accessories not
usually covered by insurance.
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ith Hearing Care Solutions, you can save up to 63%
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on a large selection of hearing aids. You’ll also save on
batteries and in-office service (for one year) and get free
cleanings, checks and battery-door replacements for the
life of your hearing aid.
With Amplifon Hearing Health Care, you save on hearing
aids (including programmable and digital types), batteries,
hearing exams and hearing aid repairs.
Fitness Discounts
To use your discount, simply visit a participating provider
and show your Aetna member ID card. You can choose
from thousands of providers, including national chains,
such as Pearle Vision®, Lenscrafters®, JCPenney® Optical,
Target Optical® and participating Sears Optical® locations.
To find a provider, use DocFind at www.aetna.com.
Enter “Vision discounts” in the “What are you looking for?”
box, then click “Vision Routine Eyewear and Exam” for a
provider directory.
With the Aetna fitness discounts, you and your covered family
members can get discounts on health club memberships* and
certain home exercise equipment and videos. The program
is offered through GlobalFit®, one of the nation’s leading
providers of fitness services and facilities, with more than
10,000 locations nationwide. Discounts include special
membership rates, free guest passes,** guest privileges
and easy billing through your bank account or credit card,
as well as access to at-home weight-loss programs and
personal health coaching.
*At some clubs, program participation may be available only to new
club members.
**Not available in all areas.
To learn more about your discounts and get started using
them, log in to Aetna Navigator at www.aetna.com. On your
home page, click on Health Programs in the top bar and you’ll
see the link for Get Discounts.
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Natural Products and Services Discounts
More savings!
Aetna uses its bargaining power to offer you and your covered
family members discounts on complementary health and
wellness products and services through the Aetna natural
products and services discounts. Offered by ChooseHealthyTM,
the program provides discounts on:
Aetna also offers discounts on:
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cupuncture
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hiropractic care
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assage therapy
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utrition counseling from registered dietitians
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Aetna Member Services: 1-800-367-6276
Once you’re enrolled in an Aetna plan, help and information
are just a phone call or e-mail away. You can contact Aetna
Member Services:
The program also provides discounts on healthy lifestyle
products, including over-the-counter vitamins, herbal and
nutritional supplements, aromatherapy, yoga equipment and
more at www.choosehealthy.com.
For information about network doctors and hospitals,
including a doctor’s credentials and if he or she is
accepting new patients
n For information about benefits under your plan
n To precertify hospital care, if required
n To check the status of a claim or benefit payment
n To request replacement ID cards
n For eligibility questions
Member Services representatives are available 24/7 at
1-800-367-6276. You may also send an e-mail to Member
Services through Aetna Navigator (www.aetna.com) once
you’ve registered.
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You can find participating natural therapy professionals on
DocFind. To use the discounts, visit one of the participating
providers, show your Aetna ID card, and pay the special
discounted fee when you receive the service.
Weight Management Discounts
The Aetna weight management discounts offers special rates
on today’s most popular weight-loss programs and meal
plans. You can save on:
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Sonic toothbrushes and water-jet flossers from Waterpik®
An automatic home blood pressure monitor with Omron
Books and other items from the American Cancer
Society® bookstore and MayoClinic.com bookstore
Yoga DVDs, books and online videos through Pranamaya®
alorieKingTM – Join an annual or monthly program and get
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a 7-day free trial period.1 You’ll receive a discount when
you continue your annual program membership.2 Save on
products in the online Store, search an extensive food
database, and more.
Jenny Craig® – Choose from a free 30-day program or a
discount on a Premium Program.3 Get weekly face-to-face
support at one of over 450 locations or talk with counselors
by telephone.
Nutrisystem® – Save on any 28-Day Nutrisystem Success
meal plan.4 Enjoy a larger discount when you sign up for
Auto-Delivery.5
You can cancel your program membership at any time during the first 7 days
by logging in to the program and following the instructions in Payment and
Account Detail under Account Settings. If you don’t cancel during the first
7 days, your credit card will be charged on the 8th day.
1
If you are already a CalorieKing member, you will need to terminate your
current account and rejoin to receive the Aetna discount.
2
Plus the cost of food. Plus the cost of shipping (if applicable). Offer applies
to initial enrollment fee only and is valid only at participating Centers and
through Jenny Craig At Home. Each offer is a separate offer and can be
used only once per member. No cash value. Restrictions apply.
3
The Aetna discount offers do not apply to any plan in which you are already
enrolled. To receive the discount, you must wait until your current plan ends.
If you are enrolled in Auto-Delivery, you must cancel it and then re-enroll to
receive the Aetna discount.
4
Offer good on new 28-Day Auto-Delivery orders only. With Auto-Delivery,
you receive a discount off Nutrisystem’s regular 28-Day Plan price and free
shipping to the continental U.S. only.
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Enrollment Instructions
During Open Enrollment
New Employees and Newly Eligible Employees
If you are currently enrolled in Choice POS II, your coverage
will automatically continue as long as you and any covered
dependents remain eligible. Your current medical plan election
will remain in place unless there has been a network change
in your area. For example, if you are currently enrolled in
Traditional Choice and, due to a network change, Choice
POS II is now established in your area, you will automatically
be converted to the Choice POS II Plan. If you are eligible
and decide to make a change for next year, you will need
to complete the enrollment process.
Newly hired and newly eligible employees must enroll within
31 days of eligibility in order to have coverage under the
DoD NAF Health Benefits Program. Otherwise, you will need
to wait for the next Open Enrollment period to enroll in
the plan. To enroll, go to www.nafhealthplans.com.
There you will find detailed information about the plans
available to you, and instructions for enrolling.
To enroll for benefits and/or make changes to current elections,
go to www.nafhealthplans.com. There you will find detailed
information about the plans available to you, and instructions
for enrolling.
Dependent Eligibility
During Open Enrollment, you may add or delete dependents
from your coverage.
You may also enroll as dependents:
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our adult children through the entire month of their 26th
birthday, even if they no longer live with you, are no longer
students, and whether or not coverage is available to them
through an employer health plan or spouse’s employersponsored health plan. Supporting documentation to
validate the parent-child relationship will be required.
Your same-sex domestic partner and his/her eligible
children. Supporting documentation to validate the
relationship will be required.
Same-Sex Spouse Eligibility
On June 26, 2013, the Supreme Court ruled that Section 3
of the Defense of Marriage Act (DOMA) was unconstitutional.
As a result, same-sex spouses of eligible NAF employees and
retirees are able to access the same benefits available to
opposite sex spouses under the DoD NAF Health Benefits
Program. Enrollees who were married to a same-sex spouse
before June 26, 2013 should notify their respective NAF
employer for enrollment actions.
Retirees
If you are currently enrolled in Choice POS II, your coverage
will automatically continue. Once you and all covered family
members reach age 65, you will be moved to Traditional
Choice. Remember that you must enroll in Medicare Parts
A and B once you turn 65. Eligibility criteria for continuing
coverage after retirement apply.
You may make changes to your coverage elections during
the year if you have a qualified family status change. Please
contact your supporting Human Resources Office for detailed
information and instructions.
Coverage for Newborns
In order for your newborn to be covered, you must enroll your
baby in the plan within 31 days of his or her birth date.
Coverage will be effective as of the date of birth. Please
contact your supporting Human Resources Office
for details.
Dual Eligibility
Keep in mind that you cannot be covered under the plan as
both an employee and a dependent, or as a dependent of
more than one employee.
Also, you cannot be covered under the plan as an active by
one NAF employer and as a retiree by another NAF employer.
This brochure highlights the key features of the DoD NAF Health Benefits Program. It does not attempt to cover all plan details, which are contained
in the official Plan Documents and insurance contracts that govern the operation of the various plans within the program. Please reference the Summary
Plan Description (SPD) for a complete description of benefits, exclusions, limitations and conditions of coverage. Should there be any conflict between the
information in this brochure and the provisions of the legal documents and contracts, the terms of those documents and contracts will control.
Android and Google Play are trademarks of Google, Inc. Apple, the Apple logo, and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries.
App Store is a service mark of Apple, Inc.
CCG DoD-0091 OC (10/15)
©2015 Aetna Inc.